| NPI | 1457310195 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IN 01069078A) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KY 39720) |
| Enumeration Date | 2006-03-21 |
| Last Update Date | 2011-06-26 |